Utilizing Community Partnerships Utilizing Community Partnerships with a Rural and Remote Memory with a Rural and Remote Memory Clinic to Develop Assessment Clinic to Develop Assessment Instruments and Protocols Instruments and Protocols Appropriate for Aboriginal Appropriate for Aboriginal Seniors Seniors UNIVERSITY OF SASKATCHEWAN UNIVERSITY OF SASKATCHEWAN Saskatoon, Saskatchewan, Canada. www.usask.ca original Experiences in Aging skatoon, SK ptember 17-19, 2008
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UNIVERSITY OF SASKATCHEWAN Saskatoon, Saskatchewan, Canada. usask
Utilizing Community Partnerships with a Rural and Remote Memory Clinic to Develop Assessment Instruments and Protocols Appropriate for Aboriginal Seniors. Aboriginal Experiences in Aging Saskatoon, SK September 17-19, 2008. UNIVERSITY OF SASKATCHEWAN - PowerPoint PPT Presentation
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Utilizing Community Partnerships with a Utilizing Community Partnerships with a Rural and Remote Memory Clinic to Develop Rural and Remote Memory Clinic to Develop Assessment Instruments and Protocols Assessment Instruments and Protocols Appropriate for Aboriginal SeniorsAppropriate for Aboriginal Seniors
UNIVERSITY OF SASKATCHEWANUNIVERSITY OF SASKATCHEWANSaskatoon, Saskatchewan, Canada. www.usask.ca
Aboriginal Experiences in AgingSaskatoon, SKSeptember 17-19, 2008
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Debra Morgan Associate Professor, Canadian Centre for
Health & Safety in Agriculture Margaret Crossley
Associate Professor, Department of Psychology
Shawnda Lanting Doctoral Student, Department of Psychology Travel support: Northern Scientific Training
Program, Northern Medical Services
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Canadian Institutes of Health Research Canadian Institutes of Health Research CIHR New Emerging Team (2003-2009)CIHR New Emerging Team (2003-2009)
Strategies to Improve the Care of Persons with Dementia in Rural and Remote Areas Interdisciplinary research Interprofessional training Capacity development
Rural and Remote Memory ClinicRural and Remote Memory Clinic
CIHR New Emerging Team Co-Investigators
Norma Stewart, PhD, RNProfessorAssociate Dean Graduate Studies & ResearchCollege of Nursing
Margaret Crossley, PhDAssociate Professor Director, Aging Research & Memory ClinicDepartment of Psychology
Carl D’Arcy, PhDProfessor & DirectorApplied Research/Psychiatry
Jay Biem, MD, MSc, FRCPLakeshore General Hospital, Montreal
Andrew Kirk, MD, FRCPC Professor & Head, Division of NeurologyDepartment of Medicine
Dorothy Forbes, PhD, RN Associate Professor, School of NursingUniversity of Western Ontario
Lesley McBain, PhDAssistant Professor, First Nations University of Canada
Sheri Harder, MD, FRCPCAssociate Professor, Department of Medical Imaging
Jenny Basran, MD, FRCPCAssistant Professor & Head, Department of Geriatrics
Vanina Dal Bello-Haas, PhD, PTAssociate ProfessorSchool of Physical Therapy
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Funding Partners: Funding Partners:
-CIHR Institute of Aging-CIHR Institute of Health Services &
Policy Research-CIHR Rural & Northern Health Initiative-University of Saskatchewan-Saskatchewan Health Research Foundation -Alzheimer Society of Saskatchewan-Telehealth Saskatchewan (in-kind support)
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Objectives of this presentation Objectives of this presentation To describe the development & implementation
of a telehealth-supported interdisciplinary Rural and Remote Memory Clinic
To describe the community partnerships that were essential to the development of instruments and protocols for assessing cognitive impairment in Aboriginal seniors.
Rural and Remote Memory ClinicRural and Remote Memory Clinic
What is Dementia?What is Dementia?
A progressive and typically irreversible loss of intellectual abilities, including memory, due to brain-based changes that are severe enough to interfere with daily functioning
Alzheimer’s disease is the most common form of dementia, accounting for up to 70% of all cases
Rural and Remote Memory ClinicRural and Remote Memory Clinic
What do we know?What do we know? seniors are over-represented in rural
areas 22% of towns vs. 15 % of cities
47% of seniors live in rural areas with moderate to no metropolitan influence
Estimated prevalence of dementia in SK is 18,000 and growing
Limited access to specialized dementia care services in rural and remote areas
Rural and Remote Memory ClinicRural and Remote Memory Clinichttp://www.hc-sc.gc.ca/seniors-aines/pubs/fpt_docs/fed_paper/index_e.htm
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Prevalence of Dementia (Percentage) Prevalence of Dementia (Percentage) in Canada by Age Groupin Canada by Age Group
8
2.4
11.1
34.5
0
5
10
15
20
25
30
35
Age Group
65+65-7475-8485+
CSHA. 1994
Rural and Remote Memory ClinicRural and Remote Memory Clinic
““It was like climbing a It was like climbing a mountain to get a diagnosis”mountain to get a diagnosis”
“Strategy for AD and Related Dementias in Saskatchewan”
(2004), focus group comment.
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Importance of Early DiagnosisImportance of Early Diagnosis
Reduced stress and burden to patient and family/caregivers
Treatment initiated early; implications for quality of life & cost to healthcare system
Decision making and planning for the future, prevent crisis events
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Rural and Remote Memory ClinicRural and Remote Memory Clinic
CLINIC DAYCLINIC DAY
Interprofessional Clinical Interview
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CLINIC DAYCLINIC DAY
Physical Therapy Assessment
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CLINIC DAYCLINIC DAY
CT scan
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CLINIC DAYCLINIC DAY
Neuropsychological Assessment
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The challenge for clinical The challenge for clinical neuropsychology was to prepare a neuropsychology was to prepare a test battery for the RRMC that test battery for the RRMC that was…was…
1. Brief enough to accommodate the time constraints of an IP same-day clinic
2. Sensitive to early-stage dementia
3. Adequate for differential diagnosis
4. Appropriate for cross-cultural assessment of rural and remote residents
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Interdisciplinary research Interdisciplinary research combining methods from combining methods from neuropsychology, human neuropsychology, human geography, and cultural geography, and cultural anthropologyanthropology
1. Focus groups with Aboriginal seniors at the Saskatoon Community clinic
2. Travel to Northern communities for consultation, and protocol and test development
Rural and Remote Memory ClinicRural and Remote Memory Clinic
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Community Screening Interview for Dementia (CSI’D)
Cross-cultural instrument provides an alternate assessment protocol for patients from non-majority cultures including non-English speaking patients
Modified in consultation with the Aboriginal grandmothers & northern healthcare providers
Hall et al., 1993
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Original Buschke Cued Recall Test Original Buschke Cued Recall Test
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Rural and Remote Memory ClinicRural and Remote Memory Clinic
“ “Grasshoppers & Geese”Grasshoppers & Geese”
Modification of Pyramids and Palm Trees based on harmonization approach
Culturally and geographically appropriate for older adults residing in rural and remote areas
Some examples…..
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Rural and Remote Memory ClinicRural and Remote Memory Clinic
Rural and Remote Memory ClinicRural and Remote Memory Clinic
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What we’ve learned so far about What we’ve learned so far about our modified assessment protocolsour modified assessment protocols
Modified neuropsychological tests (e.g., Grasshoppers and Geese) are extremely well received by all patients in our clinic
The modified screening protocols (CSI’D) still require some adjustment and ongoing work with our northern healthcare partners to ensure acceptability and sensitivity
Rural and Remote Memory ClinicRural and Remote Memory Clinic
What we’ve learned so far about What we’ve learned so far about our Interprofessional Clinic Modelour Interprofessional Clinic Model
Satisfaction ratings are high for telehealth and the streamlined 1-stop clinic model despite ongoing challenges related to cost and time of travel for remote northern patients and their families
We strongly promote this model of care for use with other chronic health concerns regardless of place of residence
Rural and Remote Memory ClinicRural and Remote Memory Clinic